Healthcare Provider Details

I. General information

NPI: 1821193582
Provider Name (Legal Business Name): FREDERICK PASCUAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 HIGHLAND AVE STE B
CLARKSTON WA
99403-2846
US

IV. Provider business mailing address

PO BOX 189
CLARKSTON WA
99403-0189
US

V. Phone/Fax

Practice location:
  • Phone: 509-769-2201
  • Fax: 509-758-9199
Mailing address:
  • Phone: 509-758-4652
  • Fax: 509-751-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36273
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMED-PHYS-LIC-103517
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMED-PHYS-LIC-103517
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: